Edit Research Specialist

About the Role

Impact you will make

As an Edit Research Specialist with FinThrive, you will have shared responsibility in the management of content rules within the FinThrive Claims Manager product. You will ensure data accuracy and reliability within Claims Manager and support FinThrive customers and revenue cycle management products.

What you will do

• Develop new rules based on changes in regulatory guidelines, new products and services, revenue, volume, and other considerations
• Maintain current rules based on research, regulatory changes, payer denials, rejections, RTPs
• Define rule explanations clearly and consistently with references as available
• Review and analyze regulatory guidelines, medical policies, payment policies, and coding changes for impact to rules database
• Provide clear, concise technical requirements to rules programming team and test rules prior to release/deployment
• Manage Salesforce Case queues and provide clear and timely customer facing communication in cases
• Ensure all quarterly and annual Medicare, TRICARE, Medicaid, Blue Cross, Workers' Comp, and Commercial payer updates are appropriately completed within acceptable time frames
• Maintain/expand personal knowledge of the healthcare industry, particularly in billing compliance
• Maintain acceptable workload backlog and strive for reduced turn-around time
• Provide support between customers and payers with respect to regulatory billing compliance to safeguard FinThrive and customers from HIPAA transaction set violations
• Ability to work independently
• Expand and maintain professional skillset for continued growth

What you will bring

• 2+ years of experience in U.S. healthcare industry
• Understanding of hospital and physician customer relations and internal customer processes
• Ability to read, research, analyze, interpret general business periodicals, professional journals, technical procedures or governmental regulations
• Basic knowledge of coding methodologies, including ICD-10, HCPCS/CPT, OPPS, IPPS
• Proficiency in MS Office, particularly Excel, and very detail oriented
• Ability to work both independently and in a team environment that requires quick turnaround and quality output
• Ability to adapt to change as needed
• Ability to write and communicate effectively

What we would like to see

• Associate or bachelor's degree in related field, such as Health Information Management
• Comprehensive understanding of Revenue Cycle Management processes
• Basic knowledge of X12 EDI transactions